MEDICARE: DR. THOMAS R FLYNN DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	14710	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	X07864	OTHER	MA	BCBS MA
2	147102	OTHER	MA	TUFTS HEALTH PLAN

General Provider Information

NPI Number	:	1689664849
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THOMAS R FLYNN DMD

Provider Business Mailing Address
First Line	:	PO BOX 9142
Second Line	:
City	:	CHARLESTOWN
State	:	MA
Zip	:	02129-9142
Country	:	US
Telephone Number	:	617-724-0287
Fax Number	:	617-726-2894

Provider Business Practice Location Address
First Line	:	188 LONGWOOD AVE
Second Line	:
City	:	BOSTON
State	:	MA
Zip	:	02115-5819
Country	:	US
Telephone Number	:	617-432-1434
Fax Number	:	617-432-0901

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/27/2005
Last Update Date	:	07/08/2007

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